Page 51 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Chapter 3
one or more reinterventions to re-attach the stomach to the abdominal wall and drain intraabdominal abcesses. All four patients fully recovered. In one patient (0.3%) injury to the gastric artery led to an intraoperative bleeding. This was successfully treated with diathermic coagulation. One patient (0.3%) had a postoperative herniation of omentum through the gastrostomy site, requiring a revision of the gastrostomy. Perforation of adjacent organs, acute intestinal obstruction and volvulus did not occur.
In 221 patients (73.7%), 408 minor complications occurred. In 38 patients (12.7%) minor complications required reintervention. Hypergranulation (n=132; 44%) was the most frequently encountered minor complication. The initial treatment was application of silver nitrate. In three patients a surgical debridement was eventually needed. Gastrostomy site infection occurred in 74 patients (24.7%), requiring oral antibiotics in 66 patients and antifungal medication in 8 patients. Leakage of gastric contents via the gastrostomy site occurred in 72 patients (24.0%). This was treated conservatively in the majority of patients (n = 60; 20.0%) by temporarily removing the tube or button in order to reduce the diameter of the gastrostomy or by temporary reduction of enteral feeding. Seven patients (2.3%) temporarily received a nasoduodenal catheter to bypass the stomach and consequently reduce the gastrostomy opening. In five patients (1.7%) the gastrostomy had to be revised in the operating theater. No correlation was found between leakage of gastric contents and the time when feeding via the gastrostomy tube was initiated. Dislodgement of the gastrostomy tube occurred in 63 patients (21.0%), requiring reintroduction. In one patient, a fausse route was created during reintroduction. This patient required laparoscopic closure of the fausse route and repositioning of the gastrostomy.
Table 3. Complications of LGP (n=300).
Complications
n (%)
Major complications
6 (2.0%)
Postoperative dehiscence of stomach wall
4 (1.3%)
Intraoperative bleeding
1 (0.3%)
Postoperative omental herniation
1 (0.3%)
Minor complications*
408
number of patients with minor complications
221 (73.7%)
Hypergranulation
132 (44.0%)
Stomal infection
74 (24.7%)
Leakage at gastrostomy site
72 (24.0%)
Dislodgement of the catheter
63 (21.0%)
Obstruction of the catheter
19 (6.3%)
Non- closure of gastrostomy site
12 (4.0%)
Ectopic gastric mucosa
8 (2.7%)
Others
28 (9.3%)
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